A Decision…

Suicide was a criminal offence in Canada until 1974. In that year, however, the government of Prime Minister Trudeau amended the Criminal Code. No longer could the state criminally prosecute a person who attempted but failed to take his or her own life. Suicide was de-criminalized in 1974; but counselling or assisting suicide continued to be an offence, under Section 241 of the Code. This seeming paradox – that one commits a criminal offence by counselling or assisting someone to do an act which is itself now legal – can be explained by a desire to protect vulnerable people.

-Arthur Schafer, University of Manitoba

On February 6, 2015, the Canadian Supreme Court unanimously voted to overturn its ban on physician assisted suicide. Parliament and the provincial governments are now tasked with creating legislation which will regulate its implementation over the next year, during which time the act of physician assisted dying remains illegal. The ruling follows the Canadian Medical Association (CMA) policy amendment in August 2014 to allow physicians to “follow their conscience when deciding whether to provide medical aid in dying,” and the Quebec legislation of June 2014 which legalized physician-assisted death. The court did clarify that the decision does not compel physicians to provide assistance in dying.

The ruling has, for many, raises more questions than it answers. As the legislation remains nonspecific at present, concerns of which patients will be eligible for assisted dying, whether a life limiting illness will be necessary, whether only physical suffering or psychological suffering as well will qualify, and how consent will be obtained, remain outstanding. There is additionally the concern of assisted dying potentially being used on those who are not consenting adults or who are especially vulnerable, such as the elderly, disabled, patients with psychiatric illness and those in institutions such as long term care facilities.

It must be stressed that the intentional act of ending someone’s life is not part of palliative care. In the throes of the debate on the right-to-die, the right to good palliative care can become something of an afterthought. It is known that hospitals that have developed palliative care programs have fewer 30-day readmissions, lower in-hospital mortality rates, and shorter lengths of stay. Yet, at present, there remains a paucity of palliative care beds in Canada, and depending on one’s geographic location, good palliative care is not an option for everyone. In the face of the Supreme Court decision, it is crucial that the importance of good, comprehensive palliative care services be recognized and appreciated, and that access to quality palliative care continue to be promoted.

For many Canadians, the Supreme Court ruling has stirred mixed emotions. There is an appreciation of the fear of a progressive illness that would potentially rob a person of their quality of life, yet there is also some difficulty in reconciling the idea of any “therapy” or “treatment” that ends a person’s life explicitly, or sends the message that perhaps their life is not worth living. Those of us that work in the medical field are additionally left to ponder the meaning of the words compassion, dignity, empathy and respect in relation to how we approach and care for patients and families at critical and vulnerable times in their lives.

Regardless of one’s position on medically assisted dying, the Supreme Court ruling has brought us into a new era. The contributions of the palliative care community will continue to be essential in shaping the delivery of end-of-life care in Canada. For myself, one of the pearls of working in palliative care has been the realization that there is enough humanity around each of us to assist not in ending a patient’s life, but in contributing meaning and fulfilment to the lives of our patients who are affected with life-altering conditions and who ask us to walk alongside them on their journey.